Saturday, September 7, 2013

ProMED MERS-CoV - Eastern Mediterranean (67): Saudi Arabia, WHO

Published Date: 2013-09-06 23:12:03
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (67): Saudi Arabia, WHO
Archive Number: 20130906.1928088
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Saudi Arabia, new cases, deaths - MOH
[2] Global update - WHO

[1] Saudi Arabia, new cases, deaths - MOH
Date: Fri 6 Sep 2013
From: Ziad M. Memish, M.D. <> [edited]

As an update on cases of MERS-COV in KSA [Kingdom of Saudi Arabia], the MOH [Ministry of Health] released the report on 4 new cases yesterday [5 Sep 2013]:

- A 41-year-old female health care worker from Riyadh with no comorbidities with onset of symptoms on [15 Aug 2013] with cough and fever. Developed severe pneumonia requiring intubation and ventilation in critical care unit. There was no history of contacts with animals or a positive case. Patient condition deteriorated and she passed away. Investigation of source is still ongoing.

- A 30-year-old Saudi male health care worker from Riyadh who is a contact of a positive case, and who developed severe pneumonia and intubated [4 Sep 2013]. The patient is currently in critical condition.

- A 79-year-old Saudi female from Hafr Albatin province, a contact of a positive case from [21 Aug 2013]. Presented with respiratory symptoms and her condition deteriorated and passed away [2 Sep 2013].

- A 47-year-old Saudi male from Hafr Albatin province, a contact of a positive case, with onset of symptoms [23 Aug 2013]. Patient condition deteriorated, requiring critical care, and he is still under treatment in critical condition.

Detailed investigation of all cases is ongoing.

Ziad A Memish, MD, FRCP(Can), FRCP(Edin), FRCP(Lond), FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia

[2] Global update - WHO
Date: Fri 6 Sep 2013
Source: WHO Global Alert and Response [edited]

Middle East respiratory syndrome coronavirus (MERS-CoV) - update 6 Sep 2013
[4 Sep 2013] - WHO has been informed of an additional 2 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The 1st case was notified by the Ministry of Health in Tunisia. The patient was a 66-year-old man who became ill on 1 May 2013 and died on 10 May 2013. The patient was earlier announced as a probable case while his daughter and son were laboratory-confirmed with MERS-CoV (DON [disease outbreak news] published on 22 May 2013). Laboratory confirmation on the case was recently conducted by the US Centers for Disease Control and Prevention.

The 2nd case was notified by the Ministry of Health in Qatar. The patient was a 56-year-old woman with underlying medical conditions who became ill on [18 Aug 2013] and died on [31 Aug 2013]. Laboratory confirmation was recently conducted by Public Health England, UK.

Globally, from September 2012 to date, WHO has been informed of a total of 110 laboratory-confirmed cases of infection with MERS-CoV, including 52 deaths.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations.

Specimens from patients' lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhoea, in patients who are immunocompromised.

Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.

All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions.

WHO has convened an Emergency Committee under the International Health Regulations (IHR) to advise the Director-General on the status of the current situation. The Emergency Committee, which comprises international experts from all WHO Regions, unanimously advised that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[With the inclusion of the 5 newly confirmed cases of MERS-CoV infection, including 2 deaths in Saudi Arabia, and the one retrospectively confirmed fatal MERS-CoV infection in Tunisia, the new global total of laboratory-confirmed cases of MERS-CoV infection will be 116, including 55 deaths. The 4 newly confirmed cases in Saudi Arabia are a bit disconcerting, as all 4 have had serious disease (including 2 deaths and 2 currently in critical condition), and none of the 4 are reported to have co-morbidities, a finding that predisposed to more serious disease. We await further information on investigations surrounding these cases, including information on the virus(es) identified in these cases.

As a reminder, the retrospectively confirmed case in Tunisia had a history of travel to Saudi Arabia and Qatar prior to the onset of illness and had been considered a "probable case" (while the original laboratory testing was negative for the MERS-CoV, 2 close contacts of him did test positive for the MERS-CoV; see MERS-CoV - Eastern Mediterranean (05): Tunisia ex Saudi Arabia/Qatar, fatal, RFI 20130520.1725864).

For a map of the Middle East, see - Mod.MPP]

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